Asthma

Asthma is an inflammatory condition of the lungs. During an attack, a person with asthma may experience significant wheezing and/or shortness of breath. The airways of the lungs are made of a cartilage scaffold surrounded by a thin layer of muscle. This muscle relaxes and contracts, causing either dilation or constriction of the airways. For many reasons, asthmatics have developed hyper-reactive lung airways that constrict easily and at times rather violently in response to certain environmental triggers. The origin of an asthma attack is inflammatory cells that secrete substances that cause muscle constriction. Allergens, smoke, chemical pollutants, exercise, cold air exposure, viral infections, or medications may all be responsible for triggering inflammatory cell activation and subsequent bronchial constriction.

Treatment

Inhaled, short-acting bronchodilators (Albuterol, Proventil) cause airway muscle relaxation and are effective for treating asthma attacks. Inhaled, long-acting bron-chodilators (Salmeterol, Fomoterol) are effective for preventing asthma attacks. Inhaled steroids (multiple brands) inhibit the increase and activity of inflammatory cells. They are the most effective medications with the lowest side effect profiles to prevent asthma attacks. Accolate and Singulair slow down the activity of inflammatory cells and are additional, effective medications that may help prevent attacks.

Asthmatics should be aware of and avoid their personal environmental triggers. If you are an asthmatic with outdoor allergens, choose lodging with central air conditioning or heating, and keep doors and windows closed. Avoid rooms with significant dust or molds and hotels with pets. If you have dust mite allergies, bring your own pillowcases to decrease exposure to them.

Varying levels of seasonal pollens, weather changes, and air current variability can make each day different for many asthmatics. One way to predict the variable nature of asthma is to measure a daily, morning time peak flow. You measure a peak flow by blowing into a hand-held peak flow meter. The device records how strong your breath flow is. If your airways are tightening, your peak flow will start to decline, so you may be able to predict an attack even before it happens.

Many asthmatics can adjust their medications or take a short course of oral steroids to avoid an attack. For a complete explanation of how to use your peak flow meter to adjust your medications, consult with a primary care physician or asthma specialist.

Emergency Care

In the event of an asthma attack, we always recommend that you seek medical attention early, especially if you do not improve with the usual home treatment. Airway constriction can be so severe that you completely lose the ability to breathe. Even people who normally only experience mild symptoms can experience a rare, life-threatening episode. If you are having a severe attack, stay calm and use short-acting bronchodilators (see above). Nebulized solutions of Albuterol are preferred to metered dose inhalers during flares.

We urge a trip to the emergency room if the sufferer displays an inability to speak, neurological changes such as confusion or slurred speech, labored breathing, exhaustion, bluish skin, or grunting with breathing. If you cannot hear wheezing, it may mean that the airways are so constricted that you can no longer hear any air flow at all.